PCOS Symptoms: Why Acne, Weight and Irregular Cycles Are Connected
The PCOS symptoms that bring most women to my clinic — acne along the chin and jaw, weight that won't shift no matter what they try, hair growing where they don't want it, cycles that turn up whenever they feel like it — usually look like a handful of separate problems. They're not.
In most cases they trace back to one root: insulin. When insulin runs high, it lowers a protein called SHBG, which frees up more testosterone to circulate — and that free testosterone is what you're seeing in the mirror. The hopeful part is that blood sugar and insulin are among the things you have the most power to change.
I was nineteen when a pelvic ultrasound gave me a diagnosis of PCOS. Severe acne, six months without a period — I ticked every box. There was very little useful information at the time; when I took the latest research to specialists, some of them knew less about it than I did. So I understand, from the inside, how it feels to be handed a diagnosis and a script and very little explanation of what's actually going on in your body. That's the gap I want to close in this post — because once you understand the mechanism, your PCOS symptoms stop looking like random bad luck and start looking like something you can influence.
Most of what I'm going to describe runs through one hormone that has nothing to do with your reproductive organs and everything to do with your breakfast: insulin.
The thread connecting your symptoms: insulin
Insulin is the molecule responsible for transporting sugar out of your blood and into your cells, where it's used for energy. Insulin resistance is what happens when that molecule stops doing its job as efficiently as it should. The cells stop responding well, so to get the same amount of sugar moved, your body has to produce more insulin. You end up running on chronically higher insulin levels and more erratic blood sugar — and that background state is what drives so many of the symptoms women don't realise are connected.
There are usually two things underneath it. The first is genetic — very often there's diabetes or pre-diabetes somewhere in the family. The second is dietary. Highly processed carbohydrates make up most people's predominant diet, and that puts enormous, constant pressure on the insulin system. Processed food also disrupts the gut microbiome, which in turn affects the way your body handles blood sugar. And then there's stress which produces cortisol, this raises blood glucose directly and asks your already-strained insulin to work harder still.
I want to name something here, because it catches a lot of women out: you can be slim and still be insulin resistant. What weight you carry is defined by many things at once — your gut microbiome, your thyroid, your inherent metabolism, and your blood sugar. You can look lean and still have blood sugars that are out of balance and insulin running high, quietly doing damage. It's also ageing you. Many women don't feel the full effect of it before forty — and then, after forty, all of it seems to arrive at once.
What high insulin does to your hormones — the SHBG piece
Here's the part almost nobody explains. There's a protein made by your liver called SHBG — sex hormone binding globulin. Its job is to bind onto sex hormones, including testosterone, and keep them in check. When testosterone is bound to SHBG, it's held in reserve. When it's not, it circulates freely and acts on your skin, your hair follicles, your whole system.
Insulin and SHBG have an inverse relationship. Your liver only has so much energy to allocate, and when that energy is being directed toward managing high insulin, it's directed away from producing SHBG. It's the body doing exactly what it's built to do — prioritising functions for survival ahead of functions for reproduction. High insulin is a survival signal, so it gets the resources. SHBG drops.
And when SHBG drops, more of your testosterone is left free to circulate. This is the lightbulb moment I love watching land in the clinic, because it reframes everything: in many cases your hormones aren't wildly overproduced and your body isn't broken. Your sugars are out of balance, and that's what's freeing up the testosterone. It sounds like a small distinction. It isn't. It means your body is actually doing the right thing under the circumstances it's been given — and it means you have enormous control over this through what you choose to eat.
Why the weight won't shift — and why training harder backfires
If there's one piece of advice I'd like to retire, it's "just lose weight." Women with PCOS are handed it constantly, and it profoundly misunderstands the biology.
When you're in insulin resistance, you will not lose weight easily — the same effort that works for someone else simply doesn't produce the same result for you. And here's the cruel loop: the harder you exercise, the more cortisol you produce; the more cortisol you produce, the worse the insulin resistance gets; and the worse the insulin resistance, the more weight you hold. So the more you throw yourself at intense exercise, the more the scales can dig in. For women with PCOS, more is not better. The formula for weight loss is genuinely different than it is for other people.
But it does move. When you change the factors actually causing the insulin resistance — and support the gut and the nervous system alongside it — weight loss does happen. It just happens as a consequence of fixing the root, not as a result of punishing yourself in the gym.
The symptoms that surprise women most
The one I see most often is hirsutism — hair growing in a male pattern, along the jaw, chin, upper lip, sometimes the chest and stomach. That's free testosterone acting on the hair follicles.
The acne follows the same logic. PCOS acne tends to sit along the chin and jaw, and often across the cheeks, chest and back — and it behaves differently from teenage breakouts, often with a cyclical pattern. If you've been put on the pill or Roaccutane for it, I'd gently point out that those have controlled the symptom — they haven't changed the underlying imbalance producing it. The moment the medication comes off, the driver is usually still there.
PCOS — recently renamed PMOS, Polyendocrine Metabolic Ovarian Syndrome, by The Lancet's international consensus precisely to reflect that it's a metabolic condition, not just an ovarian one — sits at the centre of your long-term health. The symptoms on your skin are messages about what's happening on the inside.
My own story — from a diagnosis to a normal scan
My PCOS was predominantly insulin-driven, and also cortisol-driven. Balancing my blood sugars and changing my gut microbiome was challenging work, but it wasn't the hardest part. The hardest part — the piece that changed everything — was learning to run my nervous system differently. Cortisol is the great controller. When that piece is out, it governs every other system in your body, for the worse. When it finally fell into place for me, my PCOS really changed, and I had a regular period from my mid-twenties onward.
And it kept changing as I went deeper. My skin cleared. The hirsutism settled. The pattern loosened its grip year after year, to the point where now, even when my blood sugars go out, my cycles don't.
Here's the fact I come back to more than any other. At nineteen, a pelvic ultrasound diagnosed me with PCOS. At thirty-five, the same test showed completely normal ovaries. "If you take one thing from this post, take this: you have not been handed a life sentence. You have far more power over your health than you've been told."
Katie's perspective — where I actually start
When a woman comes to me with PCOS, I don't start with her hormones. I start with her blood sugar, because that's the domino that knocks the others over.
The most useful thing I do is get real data. HbA1c gives me a three-month average of blood sugar, but the single most illuminating tool is a continuous glucose monitor — a CGM. Wearing one for a couple of weeks shows you exactly which foods, in your particular body, are spiking your blood sugar. That equation is different for everyone, and until you can see your own, you're guessing. Once we have that picture, we look at specific dietary change, and then supplements and herbs where they're indicated.
The interventions I use and stand behind are unglamorous and effective. A herbal bitter with apple cider vinegar taken before meals helps a great deal with how you handle the sugar in that meal. Cinnamon every day. Magnesium is essential. Inositol earns its place for many women. And walking after meals — genuinely one of the most powerful, most underrated things you can do for your blood sugar.
Alongside all of that, acupuncture does something I find remarkable: it helps settle the nervous system out of the stress state that keeps cortisol high, and it helps restore the menstrual rhythm. There's a growing body of research behind it — a 2025 review of 43 randomised controlled trials involving 4,827 participants found acupuncture improved ovulation in PCOS. Read the research. A separate 2025 analysis found it improved key endocrine and metabolic markers. Read the research.
This is where my two trainings come together. Naturopathy gives me the functional testing, the food work, and the herbs; Traditional Chinese Medicine gives me the acupuncture and the nervous-system piece. I'm the only practitioner in Auckland working across acupuncture, naturopathy and herbal medicine under one roof, and PCOS is exactly the kind of condition where that integration matters — because it's never only one system that needs attention.
What I won't do is promise you a timeline. Every person arrives with a different story and patterns that are more or less entrenched, and I'm not willing to pretend otherwise. What I can tell you is that this is changeable — I've watched it change in hundreds of women, and I've lived it in my own body.
Next steps — if you want to get to the root of it
If your PCOS symptoms have you frustrated with advice that only ever manages the surface, that's exactly what my women's health support in Auckland is built to look underneath. I've also written more specifically about PCOS, PMOS and how they connect to fertility if that's the piece on your mind.
If you'd rather just talk it through, the initial consultation is ninety minutes — long enough for me to look at the whole picture rather than a single symptom.
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Frequently Asked Questions
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In most cases, free testosterone. When insulin runs high, it lowers a liver protein called SHBG that would normally keep testosterone bound and in check. With less SHBG, more testosterone circulates freely and acts on the skin and hair follicles — producing the chin and jaw acne and the male-pattern hair growth (hirsutism) that are so common in PCOS. So while these look like separate problems, they usually share a single root in blood sugar and insulin.
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Yes. This is one of the most misunderstood things about the condition. The weight you carry depends on many factors — gut microbiome, thyroid, inherent metabolism and blood sugar — so you can be slim and still be insulin resistant, with blood sugars out of balance and insulin running high beneath the surface. Lean PCOS is real, and the underlying metabolic picture still needs addressing even when weight isn't an obvious symptom.
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Because insulin resistance makes weight loss genuinely harder, and the usual advice can backfire. Intense exercise raises cortisol, higher cortisol worsens insulin resistance, and worsening insulin resistance makes you hold more weight. For women with PCOS, more exercise is not better. Weight tends to shift as a consequence of correcting the underlying insulin resistance and supporting the gut and nervous system — not from training harder.
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It can genuinely change. Medication like the pill or Metformin or Roaccutane controls the symptoms but doesn't address the imbalance producing them. Working at the root — blood sugar, insulin, the gut, and the nervous system — is what shifts the underlying condition.
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Get real data on your blood sugar. An HbA1c gives a three-month average, but a continuous glucose monitor worn for a couple of weeks shows exactly which foods spike your blood sugar in your particular body — and that's different for everyone. From there, targeted diet changes, a few well-chosen supplements and herbs, walking after meals, and support for the nervous system do the real work of getting to the root rather than chasing the symptoms.